Provider Demographics
NPI:1770817504
Name:MANASSAS MIDWIFERY AND WOMEN'S HEALTH CENTER
Entity Type:Organization
Organization Name:MANASSAS MIDWIFERY AND WOMEN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNM
Authorized Official - Phone:703-330-3285
Mailing Address - Street 1:8424 DORSEY CIR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8301
Mailing Address - Country:US
Mailing Address - Phone:703-330-3285
Mailing Address - Fax:703-330-3286
Practice Address - Street 1:8424 DORSEY CIR
Practice Address - Street 2:SUITE #101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8301
Practice Address - Country:US
Practice Address - Phone:703-330-3285
Practice Address - Fax:703-330-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-26
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167746363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760620892Medicaid
VA371004OtherANTHEM